中国修复重建外科杂志

中国修复重建外科杂志

经改良 Hueter 入路治疗 Pipkin 型及 型骨折的疗效观察

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目的探讨应用改良 Hueter 入路治疗 Pipkin Ⅰ、Ⅱ 型骨折的疗效。方法2014 年 9 月—2016 年 5 月采用改良 Hueter 入路治疗 PipkinⅠ、Ⅱ 型骨折 12 例。其中男 8 例,女 4 例;年龄 32~60 岁,平均 40.2 岁。致伤原因:交通事故伤 9 例,高处坠落伤 3 例。骨折按照 Pipkin 分型:Ⅰ 型 8 例,Ⅱ 型 4 例。受伤至入院时间 2~28 h,平均 7.2 h;入院后急诊(<6 h)行髋关节复位,复位成功后 3~7 d,平均 4.3 d 进行手术,采用改良 Hueter 入路,从髋关节前方暴露股骨头骨折并予以 Herbert 螺钉加压固定。记录手术时间、术中出血量;末次随访时按照 Thompson-Epstein 评分法评定疗效。结果手术时间 80~130 min,平均 97.5 min;术中出血量 100~200 mL,平均 130.2 mL。术中复位及固定顺利,骨折达到解剖复位。12 例患者均获随访,随访时间 12~32 个月,平均 24.3 个月。术后骨折均愈合,愈合时间 15~20 周,平均 16.3 周。无切口感染、股外侧皮神经损伤、股骨头缺血性坏死、异位骨化等并发症发生。3 例患者发生创伤性骨关节炎。末次随访时按照 Thompson-Epstein 评分法评定疗效:优 5 例,良 5 例,可 2 例,优良率 83.3%。结论应用改良 Hueter 入路治疗 Pipkin Ⅰ、Ⅱ 型骨折,可充分暴露并固定股骨头骨折,具有解剖层次清晰、创伤小、手术时间短的优点。

ObjectiveTo discuss the effectiveness of the modified Hueter direct anterior approach in treatment of Pipkin typeⅠ and Ⅱ femoral head fractures.MethodsBetween September 2014 and May 2016, 12 patients with Pipkin type Ⅰ and Ⅱ femoral head fractures were treated with the modified Hueter direct anterior approach. There were 8 males and 4 females, aged from 32 to 60 years (mean, 40.2 years). The disease causes included traffic accident injury in 9 cases and falling from height injury in 3 cases. According to Pipkin typing, 8 cases were rated as type Ⅰ and 4 cases as type Ⅱ. The interval of injury and admission was 2-28 hours (mean, 7.2 hours). Reduction was performed in all patients within 6 hours after admission, and then bone traction was given. The operation was performed in 3-7 days (mean, 4.3 days) after redution. The modified Hueter direct anterior approach was applied to expose and fix femoral head fractures by Herbert screws compressively. The operation time and intraoperative blood loss were recorded, and the effectiveness was evaluated according to the Thompson-Epstein scale at last follow-up.ResultsThe operation time was 80-130 minutes (mean, 97.5 minutes), and the intraoperative blood loss was 100-200 mL (mean, 130.2 mL). All fractures achieved anatomical reduction and successful fixation. All 12 patients were followed up 12-32 months (mean, 24.3 months). All patients achieved bone union in 15-20 weeks (mean, 16.3 weeks) and no wound infection, lateral femoral cutaneous nerve injury, osteonecrosis of the femoral head, or heterotopic ossification occurred. Traumatic arthritis occured in 3 patients. According to the Thompson-Epstein scale at last follow-up, the results were excellent in 5 cases, good in 5 cases, fair in 2 cases, and the excellent and good rate was 83.3%.ConclusionThe modified Hueter direct anterior approach has the advantages of clear anatomic structure, less trauma, and shorter operation time, and it can effectively expose and fix the Pipkin typeⅠ and Ⅱ femoral head fractures.

关键词: 股骨头骨折; 髋关节后脱位; 改良Hueter入路

Key words: Femoral head fracture; posterior dislocation of hip joint; modified Hueter direct anterior approach

引用本文: 李沁, 黄富国, 项舟, 方跃, 钟刚, 易敏, 赵小丹, 刘雷. 经改良 Hueter 入路治疗 Pipkin 型及 型骨折的疗效观察 . 中国修复重建外科杂志, 2018, 32(3): 334-337. doi: 10.7507/1002-1892.201710073 复制

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